When my wife was dying (she has since passed away) and nobody could figure out her illness, she'd be in the most wretched pain, in the ER again, and she'd be retching awfully and almost uncontrollably.
A doctor would walk in, having heard of all this already and ask "How are you?"
Sometimes she gave them the benefit of the doubt, and sometimes she was a bit less charitable.
My point? Americans (as she was), Russians, Ukrainians, Latvians, Japanese, Kurdish, Bolivians, Icelandians, Koreans, Germans, Chinese, Scottish, Irish, Australians, Austrians, Swiss, South Africans, Egyptians, Mixolydians, Bohemians, and even Canadians all agree one one thing:
Being asked "How are you?" is the LAST thing somebody wants to hear when they are suffering.